Can You Spot Acute Pancreatitis in the Field?

Acute abdominal pain is a familiar chief complaint. Could this be the result of harmless indigestion, or something more severe? Here’s some key findings to help you identify acute pancreatitis.

Patient History

Alcohol abuse (Most common in males)

Gallstones (Most common in females)

Symptoms

Constant epigastric pain, which radiates to the back

Nausea & Vomiting

Fever is likely

Exam Findings

Abdominal Tenderness

Guarding of the abdomen

Cullen’s Sign (periumbilical ecchymosis)

Grey-Turner’s Sign (flank ecchymosis)

Jaundice

Shock

Patients with acute pancreatitis may develop Acute Respiratory Distress Syndrome (ARDS). This is important to keep in mind if a patient in acute respiratory distress, who has no history of such, begins to tell you about abdominal pain.

Grey-Turner’s sign and Cullen’s sign are very rare, but possible exam findings. Remember that these two findings are indicative of retroperitoneal hemorrhage, so keep you differential pool open.

There may be a chance of worsening the pain in a patient with acute pancreatitis if Morphine is used for analgesia. This is thought to occur due to the tendency of Morphine to cause spasms in the sphincter of Oddi. Hydromorphone is probably the best choice for pain control, but as always, follow local protocol.

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